A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features

Evidence for a dopaminergic link between working memory and agentic extraversion: An analysis of load-related changes in EEG alpha 1 activity

Several lines of research point to the possibility of a partially overlapping dopaminergic foundation of the trait of agentic extraversion and individual differences in working memory functioning. This study investigates interactive effects of agentic extraversion and dopamine on spectral EEG measures of working memory. Using EEG activity in the alpha 1 band (8-10.25 Hz) as a dependent variable, we tested in a randomized double-blind design the effects of the D2-dopamine antagonist sulpiride during the performance of four load-graded n-back working memory tasks in participants high versus low in agentic extraversion. We expected extraversion-related differences in the load-responsivity pattern to be reversed by sulpiride, and the alpha 1 anterior-posterior difference actually depicted this reversal effect. However, in contrast to our expectations this effect was largely due to parietal instead of frontal sites.

Caffeine as a flavor additive in soft-drinks

Over 60% of soft-drinks sold in the United States contain caffeine, a mildly addictive psycho-active chemical, as a flavor additive. Using sweeteners as controls, we assessed whether caffeine has flavor activity in a cola soft-drink. A forced-choice triangle discrimination methodology was used to determine detection thresholds of caffeine in sweeteners and a cola beverage. The subjects (n=30, 28 female, 23+/-4 years old) were trained tasters and completed over 1600 discrimination tests during the study. The mean detection thresholds for caffeine in the sweet solutions were: 0.333+/-0.1mM sucrose; 0.467+/-0.29 mM aspartame; 0.462+/-0.3mM sucralose, well below the concentration in common cola beverages (0.55-0.67 mM). A fixed concentration of caffeine, corresponding to the concentration of caffeine in a common cola beverage (0.67 mM) was added to the sweeteners and a non-caffeinated cola beverage. Subjects could distinguish between caffeinated and non-caffeinated sweeteners (p<0.001), but all subjects failed to distinguish between caffeinated and non-caffeinated cola beverage (p=1.0). Caffeine has no flavor activity in soft-drinks yet will induce a physiologic and psychologic desire to consume the drink.

Acute cortisol administration reduces subjective fatigue in healthy women

Treatment with cortisol has been found to decrease fatigue and increase feelings of vigor in both patients and healthy male subjects. We obtained self-reports of mood before 35 mg cortisol or placebo ingestion, 70 min later, and after the healthy female subjects performed cognitive tasks for 1 h in a double-blind within-subject study. Cortisol decreased fatigue, increased vigor, and tended to decrease tension. Effects on fatigue were largest after task performance, when fatigue had increased, suggesting that improvement of fatigue by cortisol is observed when subjects are fatigued. This is the first study to demonstrate improvements in fatigue in healthy female subjects; this is particularly relevant because of the high prevalence of hypocortisolimic fatigue syndromes in women and recent evidence that many psychiatric disorders may involve stress-induced hypocortisolemia that is responsive to cortisol replacement.

Coffee and health: a review of recent human research

Coffee is a complex mixture of chemicals that provides significant amounts of chlorogenic acid and caffeine. Unfiltered coffee is a significant source of cafestol and kahweol, which are diterpenes that have been implicated in the cholesterol-raising effects of coffee. The results of epidemiological research suggest that coffee consumption may help prevent several chronic diseases, including type 2 diabetes mellitus, Parkinson's disease and liver disease (cirrhosis and hepatocellular carcinoma). Most prospective cohort studies have not found coffee consumption to be associated with significantly increased cardiovascular disease risk. However, coffee consumption is associated with increases in several cardiovascular disease risk factors, including blood pressure and plasma homocysteine. At present, there is little evidence that coffee consumption increases the risk of cancer. For adults consuming moderate amounts of coffee (3-4 cups/d providing 300-400 mg/d of caffeine), there is little evidence of health risks and some evidence of health benefits. However, some groups, including people with hypertension, children, adolescents, and the elderly, may be more vulnerable to the adverse effects of caffeine. In addition, currently available evidence suggests that it may be prudent for pregnant women to limit coffee consumption to 3 cups/d providing no more than 300 mg/d of caffeine to exclude any increased probability of spontaneous abortion or impaired fetal growth.

Caffeine improves anticipatory processes in task switching

We studied the effects of moderate amounts of caffeine on task switching and task maintenance using mixed-task (AABB) blocks, in which participants alternated predictably between two tasks, and single-task (AAAA, BBBB) blocks. Switch costs refer to longer reaction times (RT) on task switch trials (e.g. AB) compared to task-repeat trials (e.g. BB); mixing costs refer to longer RTs in task-repeat trials compared to single-task trials. In a double-blind, within-subjects experiment, two caffeine doses (3 and 5mg/kg body weight) and a placebo were administered to 18 coffee drinkers. Both caffeine doses reduced switch costs compared to placebo. Event-related brain potentials revealed a negative deflection developing within the preparatory interval, which was larger for switch than for repeat trials. Caffeine increased this switch-related difference. These results suggest that coffee consumption improves task-switching performance by enhancing anticipatory processing such as task set updating, presumably through the neurochemical effects of caffeine on the dopamine system.

Caffeine: implications for alertness in athletes

Caffeine is one of the most widely consumed drugs in the world, taken socially and for its alertness- and performance-promoting actions. Extensive reports assert that caffeine increases alertness and cognitive performance levels and, when taken before exercise, demonstrates ergogenic properties. Caffeine ingestion has been associated with increased performance during endurance submaximal, and acute, high-intensity exercise. The exact mechanism of action for the performance effects of caffeine is unknown, although several physiologically and psychologically based theories exist as to how caffeine achieves increased performance capabilities. This paper outlines the known sites of caffeine activity in the body,and discusses these with respect to the effects of caffeine observed during performance assessments.

Acute effects of caffeine in volunteers with different patterns of regular consumption

RATIONALE

The effects of caffeine on mood and performance are well established. One explanation of these effects is that caffeine removes negative effects induced by prior caffeine withdrawal. This was tested here by comparing effects of caffeine in withdrawn consumers and non-consumers (who by definition were not withdrawn).

OBJECTIVES

The present study aimed to determine whether caffeine withdrawal influenced mood and performance by comparing regular consumers who had been withdrawn from caffeine overnight with non-consumers. Following this the effects of acute caffeine challenges were compared in withdrawn consumers and non-consumers. In addition, comparisons were made between those with higher and lower caffeine consumption.

METHODS

One hundred seventy-six volunteers participated in the study. Regular caffeine consumption was assessed by questionnaire and this showed that 56 of the sample did not regularly consume caffeinated beverages. Volunteers were instructed to abstain from caffeine overnight and then completed a baseline session measuring mood and a range of cognitive functions at 08.00 the next day. Following this approximately half of the volunteers were given 1 mg/kg caffeine in a milkshake or water (in the 'no caffeine' condition they were given just the milkshake or water) and the test battery repeated one hour later. A second test battery was carried out at 12.00 and a second caffeine challenge at 13.00. A final test session was carried out at 15.00.

RESULTS

The baseline data revealed little evidence of effects of caffeine withdrawal on performance and mood. In contrast to this, caffeine produced a number of significant improvements in performance. There were some differences in the effects of caffeine on regular and non-consumers, with caffeine tending to reduce reaction time in regular consumers while the opposite was true for non-consumers.

CONCLUSIONS

The present results show little evidence of effects of caffeine withdrawal on performance. In contrast, caffeine challenge produced improvements in aspects of performance and these were often not modified by regular caffeine consumption patterns. The differences in effects of caffeine that were observed between non-consumers and regular consumers were in functions that were unaffected by caffeine withdrawal. These findings show that the observed beneficial effects of caffeine cannot be interpreted in terms of a reversal of caffeine withdrawal.

Psychostimulant and other effects of caffeine in 9- to 11-year-old children

BACKGROUND

Recent research on adults suggests that "beneficial" psychostimulant effects of caffeine are found only in the context of caffeine deprivation; that is, caffeine improves psychomotor and cognitive performance in habitual caffeine consumers following caffeine withdrawal. Furthermore, no net benefit is gained because performance is merely restored to "baseline" levels. The effects of caffeine in children is an under-researched area, with only a handful of studies being carried out in the US where children's consumption of caffeine appears to be lower on average than in the UK.

METHOD

Twenty-six children aged between 9 and 11 years completed a double-blind, placebo-controlled study. Habitual caffeine consumers (mean daily caffeine intake = 109 mg) and non/low-consumers (12 mg) were tested on two separate days following overnight caffeine abstinence. On each day measures of cognitive performance (a number search task), and self-rated mood and physical symptoms, including alertness and headache, were taken before and after administration of 50 mg of caffeine, or placebo.

RESULTS

At baseline (before treatment), the habitual consumers showed poorer performance on the cognitive test than did the non/low-consumers, although no significant differences in mood or physical symptoms were found between the two groups. There were significant habit by treatment (caffeine vs. placebo) interactions for accuracy of performance and headache, and a significant main effect of treatment for alertness. Post hoc comparisons showed that caffeine administration improved the consumers' accuracy on the cognitive test (to near the level displayed by the non/low-consumers at baseline), but that it had no significant effect on the non/low-consumers' performance. In the consumers, caffeine prevented an increase in headache that occurred after placebo, and it increased alertness relative to placebo. Again, however, caffeine did not significantly affect levels of headache or alertness in the non/low-consumers.

CONCLUSIONS

These results suggest that, like adults, children probably derive little or no benefit from habitual caffeine intake, although negative symptoms associated with overnight caffeine withdrawal are avoided or rapidly reversed by subsequent caffeine consumption.

Avaliação do efeito da cafeína no teste vestibular

Há controvérsias sobre a interferência da cafeína no teste vestibular. O café é a fonte mais rica em cafeína. Enquanto em alguns serviços os pacientes são orientados a suspender a ingestão de café 24 a 48 horas antes da realização do teste, outros não consideram necessária a suspensão da ingestão dessa bebida. OBJETIVO: Avaliar o efeito da cafeína no resultado do teste vestibular. FORMA DE ESTUDO: clínico com coorte transversal. MATERIAL E MÉTODO: Estudo comparativo, transversal, pareado. O teste vestibular foi realizado em duplicidade, com intervalo máximo de cinco dias entre um e outro exame. No primeiro teste, os pacientes foram orientados a não ingerir café 24 horas antes do exame; no segundo teste, os pacientes foram orientados a beber café como de costume. Todos os participantes tinham indicação clínica de se submeter ao teste vestibular e tinham o hábito de tomar café. RESULTADOS: Participaram do estudo 19 mulheres com idade média de 49,5 anos. O consumo médio de café foi de três xícaras por dia. As queixas de ansiedade e cefaléia foram associadas ao teste realizado com suspensão do café. Não houve diferença estatisticamente significante nos resultados dos exames realizados com e sem ingestão de café. CONCLUSÃO: A ingestão moderada de café não interferiu no resultado do teste vestibular. Considerando ser recomendável que o paciente esteja tranqüilo ao se submeter ao teste vestibular e que a meia-vida da cafeína é de apenas seis horas, sugerimos que a orientação para a suspensão súbita e completa da ingestão moderada de café antes do teste vestibular para os indivíduos habituados à ingestão diária seja reavaliada.

Evaluation of the caffeine effect in the vestibular test

Exists controversy about the interference of the caffeine in the vestibular test. Coffee is the richest source of caffeine. While in some services, the patients were oriented to suspend the ingestion of caffeine 24 to 48 hours before the vestibular test, others did not consider the suspension of this drink necessary.

AIM

To evaluate the effect of caffeine in the vestibular test result.

STUDY DESIGN

Clinical with transversal cohort.

MATERIAL AND METHOD

Sectional and matched research. The vestibular test was performed twice in the same patient, with five days interval between the exams. In the first test, the patient did not drink coffee 24 hours before the exam; in the second, the patient drunk coffee as usual. All of the participants had clinical indication for vestibular test and were used to drinking coffee.

RESULTS

Nineteen women, medium age of 49.5 years, participated. The average coffee consumption was three cups per day. The complaints of anxiety and headache were associated with the submission to the vestibular test without coffee. The exams were not statistically different comparing the results of the tests performed with and without the coffee ingestion.

CONCLUSION

The moderate ingestion of coffee was not shown to interfere in the results of the vestibular test. Considering that it is recommended that the patient be calm to be submitted to the vestibular test and that the half-life of the caffeine is only six hours, we suggest that the orientation of complete and abrupt drinking coffee suspension of moderate dose before the vestibular test for the individuals used to daily drinking coffee be reevaluated.

Effects of caffeine on performance and mood: withdrawal reversal is the most plausible explanation

RATIONALE

Although it is widely believed that caffeine can enhance human performance and mood, the validity of this belief has been questioned, giving rise to debate. The central question is whether superior performance and mood after caffeine represent net benefits, or whether differences between caffeine and control conditions are due to reversal of adverse withdrawal effects.

OBJECTIVES

To provide a focussed review of relevant experimental studies with the aim of clarifying current understanding regarding the effects of caffeine on human performance and mood.

METHODS

To avoid the shortcomings of standard placebo-controlled studies, which are ambiguous due to failure to control for the confounding influence of withdrawal reversal, three main experimental approaches have been employed: studies that compare consumers and low/non-consumers, pre-treatment and ad lib consumption studies, and long-term withdrawal studies.

RESULTS

Of the three approaches, only long-term withdrawal studies are capable of unambiguously revealing the net effects of caffeine. Overall, there is little evidence of caffeine having beneficial effects on performance or mood under conditions of long-term caffeine use vs abstinence. Although modest acute effects may occur following initial use, tolerance to these effects appears to develop in the context of habitual use of the drug.

CONCLUSIONS

Appropriately controlled studies show that the effects of caffeine on performance and mood, widely perceived to be net beneficial psychostimulant effects, are almost wholly attributable to reversal of adverse withdrawal effects associated with short periods of abstinence from the drug.

The genetics of tea and coffee drinking and preference for source of caffeine in a large community sample of Australian twins

AIMS

To investigate the genetic and environmental influences on tea consumption and their commonalities with coffee consumption; and to further examine the genetic and environmental aetiology of preference for tea/coffee.

DESIGN

A classical twin design was used in which the similarity of identical and non-identical twins is compared, enabling estimates of genetic, common environmental and unique environmental influence on the trait.

SETTING AND PARTICIPANTS

An Australian population-based sample of 1796 identical (i.e. monozygotic) and 2013 non-identical (i.e. dizygotic) twin pairs aged 16-87 years was studied, roughly three-fifths of whom were female. The sample represented approximately 70% of those approached for study participation.

MEASUREMENTS

As part of a Health and Lifestyle Questionnaire, respondents were asked how many cups of each tea and coffee they consumed per day. Additional measures of 'total tea and coffee consumption' and 'preference for coffee' were calculated.

FINDINGS

Age was positively associated with tea consumption but negatively associated with coffee preference; women consumed more beverages than men, but showed a lower preference for coffee. An inverse relation between tea and coffee consumption--larger in females (-0.41) than males (-0.34)--was supported. This association was mediated entirely by the unique environment in males, and by both the unique environment (68.3%) and genes (31.7%) in females. Tea and coffee drinking were shown to have similar heritabilities (0.46) in males, but tea consumption was influenced by common environmental factors whereas coffee consumption was not. Coffee preference was shown to be influenced by genes (0.42) and the unique environment (0.58).

CONCLUSIONS

As the patterns of genetic and environmental variation were shown to differ for tea and coffee consumption it may be more informative to retain them as separate measures of caffeine intake in future studies of stimulant use and taste perception.

Attentional bias for caffeine-related stimuli in high but not moderate or non-caffeine consumers

RATIONALE

Attentional bias for drug-related cues has been reported with a wide range of drugs, but to date the extent to which caffeine consumers show similar biases for caffeine-related stimuli has not been tested. The present study therefore examined this issue in terms of differences in attentional bias for caffeine-related words in High, Moderate and Non-caffeine consumers using a dot-probe word task following overnight caffeine abstinence.

OBJECTIVES

This study was conducted to test whether caffeine consumers show an attentional bias for caffeine-related words, and whether such biases relate to habitual levels of caffeine use.

METHODS

Sixteen High, Moderate and Non-consumers of caffeine were asked to complete a modified dot-probe task in order to measure attentional bias for caffeine-related relative to neutral control word groups. The task was completed following overnight caffeine abstinence, and participants also completed mood and caffeine-craving measures.

RESULTS

The High consumer group showed a significant attentional bias for the caffeine-related words, but no such bias was seen in Moderate or Non-consumer groups. As expected, craving for caffeine was strongest in the High consumers and weakest in the Non-consumers. Attentional bias in the High group correlated with self-reported caffeine consumption and with craving for caffeine, but neither effect was significant in the Moderate group.

CONCLUSIONS

These data confirm that High caffeine consumers show attentional bias for caffeine-related stimuli, consistent with current theories of drug addiction.

Effect of chronic caffeine intake on choice reaction time, mood, and visual vigilance

The stimulatory effects of acute caffeine intake on choice reaction time, mood state, and visual vigilance are well established. Little research exists, however, on the effects of chronic caffeine ingestion on psychomotor tasks. Therefore, the purpose of this study was to evaluate the effects of 5 days of controlled caffeine intake on cognitive and psychomotor performance. Three groups of 20 healthy males (age=22+/-3 years, mass=75.4+/-7.9 kg, body fat percentage=11.2+/-5.1%) twice completed a battery of cognitive and psychomotor tasks: after 6 days of 3 mg.kg(-1) day(-1) caffeine equilibration (Day 6), and after 5 days of experimental (0 [G0], 3 [G3], or 6 [G6] mg.kg(-1) day(-1)) caffeine intake (Day 11). Groups were randomized and stratified for age, mass, and body composition; all procedures were double-blind. Cognitive analyses involved a visual four-choice reaction time test, a mood state questionnaire, and a visual vigilance task. Experimental chronic caffeine intake did not significantly alter the number of correct responses or the mean latency of response for either the four-choice reaction time or the visual vigilance tasks. The Vigor-Activity subset of the mood state questionnaire was significantly greater in G3 than G0 or G6 on Day 11. All other mood constructs were unaffected by caffeine intake. In conclusion, few cognitive and psychomotor differences existed after 5 days of controlled caffeine ingestion between subjects consuming 0, 3, or 6 mg.kg(-1) day(-1) of caffeine, suggesting that chronic caffeine intake (1) has few perceptible effects on cognitive and psychomotor well-being and (2) may lead to a tolerance to some aspects of caffeine's acute effects.

Family history of alcoholism and response to amphetamine: sex differences in the effect of risk

BACKGROUND

Individuals at risk for alcoholism exhibit an enhanced stimulant response to alcohol. It is not known whether individuals at risk also exhibit a heightened sensitivity to other drugs with stimulant properties.

METHODS

Healthy young men and women each received, in separate sessions, placebo and 10 mg of d-amphetamine in counterbalanced order. Stimulant and sedative subjective effects were recorded before and three times after capsule administration using the Biphasic Alcohol Effects Scale. The sample comprised 19 family-history-positive (FHP; 58% women) and 53 family-history-negative (FHN; 51% women) participants.

RESULTS

As compared with placebo, amphetamine increased ratings of stimulation in the sample as a whole. In addition, the ratings revealed an enhanced, as well as a protracted, stimulant response to amphetamine among FHP men, as compared with FHN men: for FHP men, ratings of stimulation made 3 and 6 hr after amphetamine administration were greater than baseline ratings. Moreover, in FHP men, the effect of amphetamine, as compared with placebo, was most evident 6 hr after capsule administration. In contrast, despite a dose x hour interaction in FHN men, post hoc comparisons revealed no differences between the baseline and any of the postamphetamine measurements or between amphetamine and placebo ratings at any of the time points. Among women, the drug effect did not differentiate the family-history groups.

CONCLUSIONS

Consistent with previous research on alcohol, high-risk men exhibited a heightened stimulant response to amphetamine. Thus, for men, sensitivity to the stimulant properties of drugs may be an endophenotype for alcoholism. Whereas the present results suggest that women at risk do not exhibit an enhanced stimulant response to amphetamine, further study is needed, including evaluation at various points in the menstrual cycle.